This proposed research demonstration incorporates a variety of methodologies and expertise to address priority areas identified in this RFA, as well as those identified at the QuIC Patient Safety Research Summit. The focus of this application is to evaluate the effectiveness of a statewide, voluntary, peer review protected, medical error reporting system for hospitals in Georgia. This type of reporting system was developed to promote a confidential, blame-free environment to facilitate learning from medical errors. The goal of the system is to feedback what is learned to participating hospitals in order to reduce and eliminate errors through system-level changes in policy and practice. Health services researchers will use data on errors from the statewide reporting system, and hospital-level data from a variety of demonstration site hospitals, to (1) examine the effectiveness of the voluntary reporting system in reducing errors, (2) test modifications to make the reporting systems more efficient and less burdensome for reporters. Because this demonstration project will also have access to a range of information from demonstration sites, we intend to develop estimates of the financial costs of medical errors in community-based hospitals. Additionally, organizational policy experts will collect qualitative data from healthcare professionals to assess the usefulness of feedback reports generated by the statewide reporting system, identify barriers to and incentives for reporting errors to this system and implementing recommended patient safety interventions and, how these relate to the creation of an organizational culture of safety. Finally, industrial systems and human factors engineers will use the methods of systems engineering and cognitive sciences to create and test models that incorporate both the quantitative and qualitative data collected to simulate system-level responses to reduce medical errors. This research demonstration plan will also generate information and professional instruction materials on how best to inform patients (and their families) when they have been injured as the result of a medical error. In addition, the research plan incorporates a strategy to develop new information on the risk of medication errors in non-hospital settings by testing safety interventions to improve and compensate for visual and cognitive deficits in older patients living in rural areas of Georgia.